岩斜坡区脑膜瘤的显微手术治疗

Microsurgical treatment of petroclival meningiomas

目的 探讨岩斜坡区脑膜瘤的显微手术入路和保护神经的方法。方法 广东省三九脑科医院神经外科自2007年1月至2011年12月显微手术切除岩斜坡脑膜瘤31例，其中乙状窦后人路22例，联合颞枕下入路9例。回顾性分析患者的临床资料和手术疗效。结果 本组肿瘤全切20例，次全切除11例，无手术死亡病例。10例（32．26％）患者术后出现新增神经功能障碍，随访3个月．除外展神经未能解剖保留的病例外，余病例颅神经功能障碍情况均有改善。结论 经乙状窦后入路或联合颞枕下人路切除岩斜坡区脑膜瘤效果良好，选择合适的操作间隙有利于肿瘤切除和减小神经损伤。

Objective To explore surgical approach in the treatment ofpetroclival meningiomas and the methods to protect cranial nerves during the surgery. Methods Thirty-one patients with petroclival meningiomas, admitted to our hospital and received surgical tumor resection from January 2007 to December 2011, were chosen in our study; resection via retrosigmoid approach was performed in 22 patients and resection via retrosigmoid approach combined with suboccipital-temporal approach was adopted in 9 patients. The clinical data and surgical outcomes of 31 patients were analyzed retrospectively. Results Total resection was achieved in 20 patients and subtotal in 11 patients without operative mortality. Ten patients （32.26%） appeared new neurological dysfunction after the surgery; follow-up for 3 months indicated that neurological dysfunction improved in some patients. Conclusion Microsurgical resection via retrosigmoid approach or it combined with suboccipital-temporal approach are good choice for total resection of petroclival meningiomas; the key of protecting cranial nerves and resecting tumor totally is to use gaps among the nerves correctly.